Intraarticular fentanyl compared with morphine for pain relief following arthroscopic knee surgery

Abstract

Intraarticular fentanyl compared with morphine for pain relief following arthroscopic knee surgeryPurpose: To compare the analgesia produced by comparable doses of intra-articular (IA) morphine and fentanyl. Methods: Sixty-nine healthy patients undergoing arthroscopic surgery received a standardized general anesthetic of 4 mg'kg -I thiopental and 2/dg-kg -I fentanyl followed by 2 mg'kg -I succinylcholine prior to tracheal intubation and controlled ventilation. Maintenance of anesthesia was achieved with N20/O 2 and isoflurane.. At the conclusion of surgery intra-articular injection was: Group I (n =23) 50/~g fentanyl in 20 ml saline; Group II (n= 24) 3 mg morphine in 20 ml saline; Group III (n=22) 20 ml saline. Pain scores at rest using a visual analogue scale were recorded by a separate blinded observer at one, two, four, and eight hours postoperatively. Results: Pain scores at one, two, four, and eight hours were 36, 26.3, 20.9, and 12.8 vs 35.8, 33.8, 28.8, and 21.9 vs 70.5, 57.7, 58.4, and 53.6 for the IA4entanyl, IA-morphine, and control groups respectively. Pain scores were greater at all times for Group III. Pain scores for Groups I and II were similar at one hour, but thereafter were less (P < 0.001) for the IA-fentanyl group. Conclusion: Better postoperative analgesia was achieved with 50 Hg intraarticular fentanyl than with 3 mg intraarticular morphine.Objectif: Comparer I'analg&ie produite par des doses comparables de morphine et de fentanyl intra-articulaires (IA).M&hode : Soixante-neuf patients en sant~ devant subir une intervention arthroscopique ont re~u une anesth~sie g~n~rale standard avec 4 mg.kg-' de thiopental et 2/~g.kg-~de fentanyl suivis de 2 mg'kg-' de succinylcholine avant I'intubation endotrach~ale et la ventilation contr61~e. On a maintenu I'anesth&ie avec N20/O 2 et de I'isoflurane. /~ la fin de I'op&ation, rinjection intra-articulaire comprenait : Groupe I (n =23), 50 Hg de fentanyl dans 20 ml de solution sal&; Groupe II (n=24) 3 mg de morphine dans 20 ml de solution salve: Groupe III (n=22) 20 ml de solution sal6e. Les scores de douleur ont ~t~ not& au repos au moyen d'une &helle visuelle analogue par un observateur impartial distinct ~ une, deux, quatre et huit heures apt& I'op&ation. l~sultats : Les scores ont ~t~ ~ une, deux, quatre et huit heures de 36 -26,3 -20,9 -12,8 vs 35,8 -33,8 -28,8 -21,9 vs 70,5 -57,7 -58,4 -53,6 pour les patients qui ont re~u du fentanyl IA, de la morphine IA et la solution salve, respectivement. Les scores de douleur ont ~t~ plus grands, en tout temps, chez les patients du Groupe III. Les scores de douleur ont ~t6 similaires chez les patients des Groupes Iet II ~ une heure, mais moindres par la suite (P < 0,001 ) pour les patients qui ont regu du fentanyl IA. Conclusion : Une analg~sie plus efficace a &~ obtenue avec I'injection intra-articulaire de 50 Mg de fentanyl plut6t que 3 mg de morphine.

Outcome Values of Adding Sodium Bicarbonate, Dexamethasone and Fentanyl to Local Anesthetic in Peribulbar Block during Vitreoretinal Surgeries. A Randomized Prospective Study

“…In the present study fentanyl group had minimal pain score postoperatively than in other groups. IN cooperation with the study done by Vita et al [21] who found that intra-articular injection of fentanyl enhance postoperative pain and no different changes between intra-articular morphine and fentanyl in postoperative pain relief. Dexamethasone was not used before as an adjuvant to local anesthetic for ophthalmic block but used alone intravitreally, subconjunctival, and in peribulbar injection [22].…”

No evidence for analgesic effect of intra-articular morphine after knee arthroscopy: A qualitative systematic review

“…In most positive placebo-controlled trials, postoperative pain was not assessed until at least 1 hour postoperatively. 33,36,38,40,46,53,56,58,59,67,68 Negative Trials. Eleven placebo-controlled preemptive RCTs found no difference between IA morphine and placebo.…”

“…33,44,48,49,55 Some authors did not report the female/male distribution within the different treatment groups. 35,36,[38][39][40]51,56,57,59,67,68,81 Female patients report more pain after knee ar- throscopy than men do. 5 In future RCTs on IA morphine, the analyses of group data should be performed so that potential sex differences will not be lost.…”

Comparisons of analgesic effects of different doses of morphine and morphine plus methylprednisolone after knee surgery

“…Reduction of postoperative pain by injecting opioid into the knee joint is believed to support the hypothesis that peripheral opioid receptors are activated in response to inflammation [13]. The use of opioid drugs such as fentanyl, morphine [14] and meperidine [15], or even combination therapy by using an opioid plus a non-opioid drug have also been reported to reduce postoperative pain [7,8].…”